Utilization and Effectiveness of Desmopressin Acetate After Cardiac Surgery Supplemented With Point-of-Care Hemostatic Testing: A Propensity-Score–Matched Analysis

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 31; no. 3; pp. 883 - 895
• Main Authors: Orlov, David, MD, McCluskey, Stuart A., MD, PhD, Callum, Jeannie, MD, Rao, Vivek, MD, PhD, Moreno, Jacobo, MD, MSc, Karkouti, Keyvan, MD MSc
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Aged; Anesthesia & Perioperative Care; blood coagulation; cardiac surgery; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - trends; Critical Care; Deamino Arginine Vasopressin - therapeutic use; desmopressin acetate; extracorporeal circulation; Female; hemorrhage; hemostasis; Hemostasis - drug effects; Hemostasis - physiology; Hemostatics - therapeutic use; Humans; Male; Matched-Pair Analysis; Middle Aged; point of care testing; Point-of-Care Testing - trends; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Propensity Score; Prospective Studies; Retrospective Studies; Treatment Outcome; point of care testing; desmopressin acetate; extracorporeal circulation; blood coagulation; cardiac surgery; hemostasis; hemorrhage
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2016.11.022

Objectives To explore the utilization pattern and hemostatic effectiveness of desmopressin acetate (DDAVP) supplemented with point-of-care (POC) hemostatic testing in contemporary cardiac surgery. Design Retrospective, observational study. Setting Single quaternary care university hospital. Participants The study comprised 2,468 consecutive patients undergoing cardiac surgery—1,237 before and 1,231 after the introduction of POC testing. Interventions The incidence of DDAVP administration during the year before (2012) and after (2013) the initiation of POC-based viscoelastic (ROTEM; Tem International GmBH, Munich, Germany) and platelet function (Plateletworks; Helena Laboratories, Beaumont, TX) testing was determined. Propensity-score matching was used to examine the association between DDAVP administration and major bleeding during each time period. Measurements and Main Results DDAVP was administered more than twice as often after POC implementation (41% v 20%, p<0.001). Major bleeding was defined based on the universal definition of perioperative bleeding in adult cardiac surgery. Propensity matching identified 224 well-balanced pairs of DDAVP recipients and control patients before and 298 such pairs after the implementation of POC testing. After adjusting for matched data, DDAVP administration was associated with 1.70 (95% confidence interval 1.25-2.32, p<0.001) and 1.51 (95% confidence interval 1.15-1.98, p = 0.003) increases in the odds of major bleeding before and after the initiation of POC testing, respectively. Conclusions Clinicians should be cognizant of the potential for increased use of DDAVP despite limited evidence of benefit in contemporary cardiac anesthesia practice supplemented with POC-based hemostatic testing.